AAMI 2006 CONFERENCE & EXPO June 25, 2006 Washington, DC

Toshio Takeda (CE)

Mihama Hospital

Tomoyuki Yamakawa, Jeongsoo Shin, Hiroaki Sugisaki, Toyohiko Yoshida, Chikao Yamazaki

Japanese Association of Dialysis Physicians

Junji Uchino,Tatsuya Morigami, Tadayuki Kawasaki

Japan Association for Clinical Engineering Technologists

Information Sharing System for

Disaster Recovery Related to Dialysis

Treatment in Japan

(Photo：http://www.kkr.mlit.go.jp/hanshin/mati/photo/photo_01.html)

A Disaster-prone Country

Source:DISASTER MANAGEMENT IN JAPAN: DIRECTOR GENERAL FOR DISASTER MANAGEMENT, CABINET OFFICE

Number of earthquakes with magnitude of 6.0 or larger

Japan 95 (20.9%)

World 454

Others 359(79.1%)

Note: Total for 1994 to 1998 Prepared by the Cabinet Office based on data from the Japan Meteorological Agency and world data provided by USGS.

Number of active volcanoes

Japan 86 (10.4%)

World 829

Others 743(89.6%)

Note: Prepared by the Cabinet Office based on data from the Japan Meteorological Agency.

Comparison of Natural Disasters in

Japan and Other Parts of the World

An Overview of Dialysis Treatment in Japan

(as of Dec. 31, 2004)

• Number of dialysis patients 248,166 One out of every 500 Japanese citizens is a dialysis

patient.

Hemodialysis patients are predominant, accounting for 96.3% of all.

The average age is 63.3.

Patients are concentrated in and around big cities such as Tokyo, Osaka, Kanagawa, Aichi, and Saitama.

The number of patients is increasing by about 10,000 every year.

Number of kidney transplants 700-800 cases per year

• Number of dialysis facilities 3,882 Total number of patient stations at facilities 97,366

Most of the facilities use multi-patient dialysate supply systems.

Dialysis Treatment after Disasters

In January 1995, we experienced the

Great Hanshin-Awaji Earthquake that

claimed more than 6,400 victims. In

the affected area in the Hyogo

prefecture, 66 out of 104 dialysis

facilities were affected, forcing some

1,700 patients to go to other facilities to

receive dialysis. Many of the

patients visited dialysis facilities out of

the affected area on their own and

asked for treatment. The facilities that

accepted patients gave dialysis, as if it

was only natural, although the patients

could not bring any data on their

treatment. Photo：

http://www.kippo.or.jp/kc/bousai/images/bousai06.pdf

http://www.kkr.mlit.go.jp/hanshin/mati/photo/photo_01.html

Dialysis Treatment after Disasters

From this past experience, we consider the following two points as the major principles to be applied after massive disasters: 1. Patients escape to a safe area and ask for dialysis treatment there. 2. Facilities accepting the patients must give them whatever dialysis treatment possible.

(Photo：http://www.kippo.or.jp/kc/bousai/images/bousai06.pdf)

Dialysis Treatment after Disasters Needless to say, systematic responses are required

especially after major disasters. What we need is a network

for dialysis treatment after disasters.

The Japanese Association of Dialysis Physicians decided

to construct a framework of coordination with the Japan

Association for Clinical Engineering Technologists, related

organizations, and the national and local governments as

well as an information sharing system that support it.

The Japanese Association of Dialysis Physicians is an organization of doctors engaged in dialysis, which conducts investigation and research, education, and crisis control for dialysis treatment. This association has prefectural branches. The Japan Association for Clinical Engineering Technologists is an organization aimed at enhancing scientific knowledge and skills, improving capabilities, and improving the reliability of medical care and welfare supported by life support systems and other medical equipment.

Establishing a Framework of

Coordination

We called for establishment of disaster

recovery measures among local dialysis

facilities in units of prefectures.

We organized a "Disaster Information

Network" consisting of doctors and clinical

engineers commissioned by prefectural

branches of the Japanese Association of

Dialysis Physicians.

We promoted a system of liaison with the

national and local governments and dialysis-

related organizations and companies.

Disaster Communication Network center

Disaster Communication Network

Japanese Association of Dialysis Physicians

Ministry of Health, Labour and Welfare

Local chapters of

Japanese Association of Dialysis Physicians

The Emergency Medial-care or Dialysis

of Prefectural department in charge

Japan Association for

Clinical Engineering Technologists

Japan Academy of Nephrology Nursing

Faculty of Maritime Sciences, Kobe University

Japanese Society for Dialysis Therapy

Medical Device, Pharmaceutical industry

Dialysis facilities

The Superiority of the Internet after

Disasters

So we decided to use Web sites and e-mail on the

Internet, which are generally less susceptible to

these problems.

We should assume that, just after a disaster strikes, affected facilities will not be able to communicate any information to the outside. Rather, it is important that unaffected facilities send out information. If this information can be quickly collected, summarized, and distributed, we will be able to quickly identify the affected facilities and give dialysis treatment to the patients of the affected facilities elsewhere. There is also a possibility that telephones and facsimiles in and around the affected area will not be easily connected because of damages on communication equipment and incoming calls to the affected area from all over the country.

Web Site for Sharing Disaster Information http://www.saigai-touseki.net/

Message board

Links to pages for sending facility

information and reading summary

results

Dialysis Information Items to Be Collected

for Information Sharing

・Prefecture and region

・Facility name

・Person in charge

・Conditions of the affected facility

1) Building conditions

2) Lifeline conditions

3) Dialysis systems conditions

・Things mainly in short supply (such as dialyzers, extracorporeal circuits, and dialysate concentrate)

・Number of beds that you can spare in the dialysis room

・Number of dialysis patients that you can accept (in three days starting from the date of sending this information)

・Number of dialysis patients you want other facilities to accept (in three days starting from the date of sending this information)

・Means of transporting patients

・Number of volunteers that you can dispatch (such as doctors, clinical engineers, and nurses)

・Other necessary articles, messages, etc.

Use of CGI

Facility information

Summary result

Web server

Summary request

Database

CGI scripts

The Internet

What's CGI? CGI or Common Gateway Interface is defined as a standard for running external programs from a World-Wide Web HTTP server.

Web browser

E-Mail Communication Network

- Mailing Lists -

• A mailing list consisting of dialysis

facilities and related organizations as

members; aimed at extensively calling for

supply of information

• A mailing list consisting of related

organizations and persons in charge of

disaster recovery at the Ministry of

Health, Labor and Welfare and local

governments; aimed at holding disaster

recovery meetings after a disaster strikes

Website

and

mailing lists

Maintenance of the Web Site

Clinical engineers in charge of the Disaster Information Network Center make Web pages and CGI scripts and upgrade systems including mailing lists.

This Web site is constructed on servers at two locations, Tokyo and Osaka, so that at least one of them will survive when a disaster strikes.

Database

CGI scripts

Report on Major Operations in the Past

- Meeting and Training -

Disaster Information Network meeting

Once every year, the members of the Disaster

Information Network have a meeting to report

their operations.

Information exchange training

Once every year, information exchange training

is held.

A total of 1,797 facilities in 28 of 47 prefectures

took part in this training.

Tottori-ken-seibu Earthquake

Oct 2000

Heisei Geiyo Earthquake

Mar 2001

Northern Miyagi Earthquakes

Jul 2003

Tokachi-Oki Earthquake

Sep 2003

Torrential Rains in Niigata, Fukushima

Jul 2004

West off Fukuoka earthquake

Apr, May 2005

Mt. Usu Eruption

May 2000

Torrential Rains in Tokai Region

Sep 2000

Miyagi-Oki Earthquake

May 2003

Niigata Chuetsu Earthquake

Oct 2004

Typhoon 200423 (TOKAGE)

Oct 2004

Major Operations in the Past - Disasters Affecting Dialysis Facilities in and after Year 2000 -

As a example of our actual activities of “Information Sharing System” against “Niigata Chuetu Earthquake”,occured on oct.2004, I wished to explain the details this time.

However, because of lack of time and my poor english, it is impossible to explain the details.

Therefore, I enclosed these informations into my“Hand-Out”, and if you will be able to check it, it is appreciated.

For the future, we are determied to

improve the availability of this

information sharing system through

training, making most of the lessons we

learned from the disaster recovery.

Conclusion